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1. Neuro/Substance Abuse > Neuro E1 > Flashcards

Neuro E1 Flashcards

1
Q

Primary Headache Disorders 4

A

Migraine
Tension-Type Headache
Cluster Headache
Hemicrania Continua

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2
Q

Secondary Headache Disorders 7

A

Traumatic Brain Injury Headache
Pseudotumor Cerebri
Brain Tumor Headache
Reversible Cerebral Vasoconstriction Syndrome
Subarachnoid Headache
Medication Overuse Headache
Substance Withdrawal Headache

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3
Q

Migraine Aura Chateristics

A
  • Gradual onset/evolution of positive visual symptoms (shimmering lights, zigzags in vision, tingling)
  • Sequential progression (positive symptoms first then negative symptoms) OR repetitive attacks of identical nature
  • Flurry of attacks midlife
  • <60mins
  • 50% chance HA follows
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4
Q

Transient Ischemic Attack (TIA)

A
  • Abrupt visual loss
  • Simultaneous occurance of multiple neurological symptoms (vision loss and arm feeling numb at the same time)
  • < 15 mins
  • HA does not accompany
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5
Q

Diclofenac potassium oral solution (Cambia)

A

Solution NSAID (faster absp)
Needs to be mixed with 1 - 2 oz of water prior to admin

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6
Q

Celecoxib oral solution (Elyxyb)

A

Solution NSAID (faster absp)

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7
Q

Butalbital/APAP/Caffeine (Fioricet, Bac, Esgic, Zebutal)

A

NON CONTROLLED
Butalbital is a barbiturate, thus abuse potential
BBW for hepatotoxicity because of APAP
Can depress sensory cortex/alter cerebela function
LAST LINE TX MEDICATION OVERUSE HEADACHE, limit to 3days/month

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8
Q

Butalbital/ASA/Caffeine (Fiorinal)

A

C3
LAST LINE TX MEDICATION OVERUSE HEADACHE, limit to 3days/month

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9
Q

Triptans use and CI in what

A

FOR ACUTE TREATMENT ONLY, early administration for best response

Contraindicated in stroke/tia patients (so if s/sx show history then don’t use), no use within 24hrs of an ergot

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10
Q

Simple Partial Seizures Definition

A

NO impairement of consciousness
Associated with motor signs, sensory and somatosensory signs, autonomic signs

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11
Q

Complex partial seizures Definition

A

WITH impairment of consciousness, not LOSS of consciousness
Patient may present as if with a psych disorder

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12
Q

Generalized Seizures Definition

A

Tonic-clonic (involuntary muscle loss - convulsing)
All of the cerebral cortex is involved, a CORTICOL event

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13
Q

Abscence Seisures Definition

A

Only happens in childhood and early adolescence

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14
Q

Difference between Seizure and Epilepsy

A

Epilesy is a disorder of continued seizures

If seizures are caused as a side effect of recrational and illegal meds then it can progress to epilepsy.

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15
Q

Prego OK Seizure Rx

PLFEO (pregnant ladies feel especially obese)

A

Phenobarbital (a barbituate so expect baby to withdraw)
Oxcarbamazepine
Lamotrigine
Ethosuximide
Folic Acid Supplement

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16
Q

Nursing NOT OK Seizure Rx

A

Phenobarbital because the baby can become addicted

All other drugs actual newborn dose is negligible.

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17
Q

Prolongation of Na Channel INACTIVATION

A

Sodium Valproate
Carbamazepine
Phenytoin
Topiramate
Zonisamide
Lamotrigine

Shit Crap, Phinease Took Zoo Lamps

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18
Q

Inhibition of Ca Channel Current

A

Sodium Valproate
Ethosuzimide
Trimethadione

SET (inhibiting anyone coming in)

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19
Q

Faciliation of GABA mediated Cl Channel Opening

A

Barbiturate
Benzodiazepine
Vigabatrin
Sodium Valproate
Gabapentin
Tiagabine

Ben and Barb, So Very Good Tia

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20
Q

Organ Systems Effected by CHRONIC XS USE

A

CNS Effects
- Addiction
- Wernicke-Korsakoff Syndrome
- Cortical Atrophy/Dementia

Hepatic/Pancreatic
- Steatosis (Fatty Liver)
- Alcoholic hepatitis
- Cirrhosis
- Pancreatitis

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21
Q

Sensitization

A

Increased response to a drug with repeated use Shifting Dose Response Curve to the left

22
Q

Tolerance

A

a state of adaptation in which
exposure to a drug induces changes that
result in a diminution of one or more of the
drug’s effect over time
Shifting Dose Response Curve to the right

23
Q

Addiction

A

a primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations

24
Q

Drug Abuse

A

maladaptive pattern of substance use characterized by repeated adverse consequences related to the repeated use of the substance

25
Q

Dependence

A

Body adapts to presence of drug. Needs drug on board to maintain homeostasis

26
Q

Sublocade Clinical Benefits of SQ injection once a month

A
  • Reducing the diversion and abuse/nonmedical use when compared to SL tablet or film form
  • Useful in noncompliant patients because no need to take a SL tablet or film once or twice a day
27
Q

Sublocade BBW

A

Serious harm or death if admin IV/IM because it forms a block upon contact with body fluids HENCE REMS PROGRAM

28
Q

Sublocade admin doses ____days apart

A

26

29
Q

Stimulants Examples

A

Cocaine
Amphetamine
Methamphetamine
PCP
Ketamine

30
Q

Eletriptan CP

A

CI in potent CYP3A4 inhibitors needs 72hrs washout (like ketoconazole, clarithromycin, Nafazidome, and ritonavir)

Most lipophilic (can cross the BBB so more CNS Effects, but less recurrence)

31
Q

Frovatriptan CP

A

Longest half life, ONLY TRIPTAN OKAY FOR PREVENTION IN MENSTRUAL HEADACHES

32
Q

Sumatriptan CP

A

Intranasal, SQ, and PO formulations

Intranasal&raquo_space; SQ > PO for onset of action

Sumatriptan chest pain is most common with SQ, so just change to a different formulation if it’s a side effect issue

33
Q

CGRP Mabs

A

Eptinezumab
Erenumab
Fremanezumab
Galcanezumab

34
Q

Which of the CGRP mabs are a CGRP receptor?

A

Erenumab, others are CGRP ligands

35
Q

Eptinezumab Route of Administration and freq

A

IV q 3 months

36
Q

Erenumab Route of Administration and freq

A

SQ every month

37
Q

Fremanezumab Route of Administration and freq

A

SQ every month OR every 3 months

38
Q

Galcanezumab Route of Administration and freq

A

SQ every month

39
Q

Eptinezumab side effects

A

infusion reaction
Nasopharyngitis
Nausea

40
Q

Erenumab side effects

A

Injection site reaction
Constipation*** if its really bad may need to be hospitalized, consider if there are other drugs on board that are causing low GI motility

41
Q

Fremanezumab side effects

A

injection site reaction

42
Q

Galcanezumab side effects

A

injection site reaction

43
Q

Magnesium use and ADE

A

migraine prophylaxis, rec in prego

ADE: Diarrhea, N/V

44
Q

Feverfew use and ADE

A

migraine prophylaxis, AVOID IN PREGO BECAUSE MAY CAUSE UTERINE CONTRACTIONS AND ABORTIONS

ADE: GI issues (stomach pain, bloating, constipation, diarrhea, flatulence, heartburn, nausea)

45
Q

Butterbur use and ADE

A

migraine prophylaxis

AVOID PRODUCTS THAT ARE NOT LABELED AS PA FREE (PYRROLIZIDINE ALKALOIDS)

ADE: GI issues (belching, diarrhea, stomach upset), drowsy, fatigue, pruritus, rash, hepatotoxicity (rare)

46
Q

Botox use, BBW, ADE

A

for Chronic migraines

BBW: Spread of toxin effect - muscle weakness, diplopia (double vision), ptosis (eyelid drooping), dysphagia (can’t swallow), breathing issues

ADE: injection site pain, neck pain, myalgia (muscle pain), facial paresis (face paralysis)

47
Q

Lasmiditan clinical pearl and ehat level of control?

A

C5

And must wait 8hrs between dosing and driving heavy machinery because of profound cns depression

48
Q

Topiramate ADE

A

Cognitive dysfunction
CNS Effects
Nephrolithiasis
Metabolic acidosis
Angle closure glaucoma
Oligohydrosis/hyperthermia (no sweating)
Suicidal ideation

49
Q

Sodium valproate BBW

A

Hepatotoxicity
Pts with mitochondrial disease
Fetal risk
Pancreatitis

50
Q

Tricyclic antidepressants use and ade

A

Used in preventative migraine TX, #4

Ade, anticholinergic effects, cardiac conduction abnormalities

51
Q

Opioid effects of use

A

Euphoria
Dysphoria
Apathy
Motor retardation
Sedation
Slurred speech
Attention impairment
Miosis
Constipation

1. Neuro/Substance Abuse (3 decks)

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